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Ochsner Health

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Revenue Cycle Precertification Nurse

Revenue OperationsRevenue OperationsPart TimeRemoteMid LevelTeam 10,001+Since 1942H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

1 day ago

Salary

0

Seniority

Mid Level

No structured requirement data.

Job Description

Revenue Cycle Precertification Nurse

Ochsner Health

Role Description This job ensures the financial security of scheduled inpatient and outpatient (excluding ED) accounts for the company's patients by obtaining/initiating prior authorization of ordered services based on payer requirements, after benefits and eligibility have been determined. - Coordinates with physician and/or staff for appropriate level of care setting and essential clinical documentation to support medical necessity of services ordered. - Works collaboratively with Case Management to establish level of care for direct admits and inpatient stays. - Acts as a resource for the Revenue Cycle staff within Pre-Service. - Performs duties under general supervision and following moderately complex procedures and guidelines. Qualifications - Required - Licensed Practical Nurse (LPN) diploma. - Required - 3 years of hospital-based experience in the delivery of patient care. - Preferred - Ambulatory experience. - Required - Current LPN license in the state of practice. Requirements - Proficiency in using computers, software, and web-based applications. - Effective verbal and written communication skills and ability to present information clearly and professionally. - Excellent customer service skills and ability to gather and disseminate information with a diverse range of people, either in person or over the phone. - Excellent interpersonal skills including the ability to work collaboratively with other departments and functional areas and handle high-pressure, difficult situations. - Good organizational and time management skills and ability to work with minimal supervision. - Excellent decision making, critical thinking, and analytical skills and ability to pay strong attention to detail. - Proficiency in application of medical necessity criteria, standards of practice, and research regarding pre-certification guidelines. - Ability to prioritize tasks and manage multiple tasks with efficiency and quality. - Working knowledge of terminology associated with CPT and ICD-10 coding, Medicare guidelines, HMO and PPO contracts, and other insurance billing processes. Job Duties - Secures clinical documentation and performs pre-service medical necessity reviews to obtain prior authorizations. - Maintains professional and technical knowledge and certifications. - Ensures all regulatory requirements are met within the department. - Assists in the day-to-day operations of the department. - Consistently supports the company and its business services goals and core values. - Performs other duties as assigned. Physical and Environmental Demands - Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly. - Normal routine involves no exposure to blood, body fluid, or tissue, but exposure or potential for exposure may occur. - The incumbent may work with patients who have known or suspected communicable diseases and may enter isolation rooms. - The incumbent has an occupational risk for exposure to all communicable diseases. - There may be occupational risk for exposure to hazardous medications or hazardous waste within the environment.

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